Abstract
Purpose
To explore the diagnostic performance and interreader agreement of CEUS LI-RADS in diagnosing ≤ 30 mm liver nodules with different experienced radiologists.
Methods
Between January 2018 and October 2020, 244 patients at high-risk for HCC who underwent CEUS were enrolled. Two novice radiologists and two expert radiologists independently evaluated LI-RADS categories and main features. Kappa (κ) and Kendall’s tests were employed to evaluate the interreader agreement of CEUS LI-RADS. The diagnostic performance was determined based on sensitivity, specificity, accuracy, PPV and NPV.
Results
The interreader agreement for arterial phase hyperenhancement, late and mild washout, early washout, and rim hyperenhancement was moderate to almost perfect (κ, 0.44–0.93) among the different levels of radiologists. The interreader agreement for the LI-RADS categories was substantial to almost perfect (κ, 0.78–0.88). However, the interreader agreement for marked washout was fair to moderate (κ, 0.28–0.50). When CEUS LR-5 was used as a diagnostic criterion for HCC, there were no statistical differences in sensitivity, specificity, accuracy, PPV and NPV among the radiologists (p > 0.05), except for the differences between Reader 4 and the remaining three radiologists in terms of accuracy and sensitivity (p < 0.05).
Conclusion
CEUS LI-RADS has good diagnostic agreement for ≤ 30 mm liver nodules among experienced radiologists.
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References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians 71 (3):209-249. https://doi.org/10.3322/caac.21660
European Association for Study of L, European Organisation for R, Treatment of C (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. European journal of cancer 48 (5):599-641. https://doi.org/10.1016/j.ejca.2011.12.021
Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, Roberts LR, Heimbach JK (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68 (2):723-750. https://doi.org/10.1002/hep.29913
European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. Journal of hepatology 69 (1):182-236. https://doi.org/10.1016/j.jhep.2018.03.019
Leoni S, Piscaglia F, Granito A, Borghi A, Galassi M, Marinelli S, Terzi E, Bolondi L (2013) Characterization of primary and recurrent nodules in liver cirrhosis using contrast-enhanced ultrasound: which vascular criteria should be adopted? Ultraschall in der Medizin 34 (3):280-287. https://doi.org/10.1055/s-0033-1335024
Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RT, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK (2010) Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatology international 4 (2):439-474. https://doi.org/10.1007/s12072-010-9165-7
Italian Association for the Study of the L, Panel AE, Committee AC, Bolondi L, Cillo U, Colombo M, Craxi A, Farinati F, Giannini EG, Golfieri R, Levrero M, Pinna AD, Piscaglia F, Raimondo G, Trevisani F, Bruno R, Caraceni P, Ciancio A, Coco B, Fraquelli M, Rendina M, Squadrito G, Toniutto P (2013) Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 45 (9):712-723. https://doi.org/10.1016/j.dld.2013.01.012
Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, Okusaka T, Miyayama S, Tsuchiya K, Ueshima K, Hiraoka A, Ikeda M, Ogasawara S, Yamashita T, Minami T, Yamakado K, Liver Cancer Study Group of J (2014) JSH Consensus-Based Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma: 2014 Update by the Liver Cancer Study Group of Japan. Liver cancer 3 (3-4):458-468. https://doi.org/10.1159/000343875
Zheng W, Li Q, Zou XB, Wang JW, Han F, Li F, Huang LS, Li AH, Zhou JH (2020) Evaluation of Contrast-enhanced US LI-RADS version 2017: Application on 2020 Liver Nodules in Patients with Hepatitis B Infection. Radiology 294 (2):299-307. https://doi.org/10.1148/radiol.2019190878
Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsoe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen EL, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall in der Medizin 34 (1):11-29. https://doi.org/10.1055/s-0032-1325499
Shin J, Lee S, Bae H, Chung YE, Choi JY, Huh YM, Park MS (2020) Contrast-enhanced ultrasound liver imaging reporting and data system for diagnosing hepatocellular carcinoma: A meta-analysis. Liver international : official journal of the International Association for the Study of the Liver 40 (10):2345-2352. https://doi.org/10.1111/liv.14617
Huang JY, Li JW, Lu Q, Luo Y, Lin L, Shi YJ, Li T, Liu JB, Lyshchik A (2020) Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma. Radiology 294 (2):329-339. https://doi.org/10.1148/radiol.2019191086
Byun J, Choi SH, Byun JH, Lee SJ, Kim SY, Won HJ, Shin YM, Kim PN (2020) Comparison of the diagnostic performance of imaging criteria for HCCs </= 3.0 cm on gadoxetate disodium-enhanced MRI. Hepatology international 14 (4):534-543. https://doi.org/10.1007/s12072-020-10040-2
Ling W, Wang M, Ma X, Qiu T, Li J, Lu Q, Luo Y (2018) The preliminary application of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) on small hepatic nodules (</= 2cm). Journal of Cancer 9 (16):2946-2952. https://doi.org/10.7150/jca.25539
Li W, Li L, Zhuang BW, Ruan SM, Hu HT, Huang Y, Lin MX, ** Tang, Yun He & Hong Yang
Contributions
Study concepts and design: HY and YH. Literature research: HHY, ZM and ZPT. Methodology: RW and PL. Data analysis: RW, YTP, YQW and JBP. Statistical analysis: RZG, DYW and RW. Manuscript preparation: RW. Manuscript editing: RW and PL. Study supervision: HY and YH.
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Wen, R., Lin, P., Gao, R. et al. Diagnostic performance and interreader agreement of CEUS LI-RADS in ≤ 30 mm liver nodules with different experienced radiologists. Abdom Radiol 47, 1798–1805 (2022). https://doi.org/10.1007/s00261-022-03468-7
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DOI: https://doi.org/10.1007/s00261-022-03468-7